Global Disparities in Sarcoma Care Underscore Need for Timely Referral and Multidisciplinary Coordination

R. Lor Randall, MD, FACS

Suboptimal access to comprehensive care contributes to incomplete treatment and misdiagnosis in sarcoma, underscoring the need for provider awareness regarding timely referral to specialized centers and improved multidisciplinary coordination to help bridge the gap, according to R. Lor Randall, MD, FACS.

He added that although there is variability in health care systems and resources across different countries, addressing these global disparities in sarcoma care requires engagement from stakeholders across health care systems, governments, and the pharmaceutical industry, depending on the health care environment.

“The best way to address the [issue of global] access is to make sure that we raise awareness,” Randall said in an interview with OncLive® during Sarcoma Awareness Month, observed annually in July. “[This ensures] that people who aren't part of this network of providers or sarcoma specialists, refer patients to those centers and do not try to take on [disease management] themselves.”

During the interview, Randall highlighted the need for coordination among various specialists to ensure accurate diagnosis and comprehensive care, the importance of social media and advocacy groups for correcting misconceptions about sarcoma, and the need for regrading disease to ensure accurate staging for effective treatment planning.

Randall is the David Linn Endowed Chair for Orthopedic Surgery, the chair of the Department of Orthopedic Surgery, and a professor at UC Davis Comprehensive Cancer Center in Sacramento, California.

OncLive: What core components define the standard for comprehensive sarcoma care globally, and how do disparities in access to multidisciplinary expertise affect outcomes across different regions?

Randall: The United States [US] has its own set of standards [for sarcoma care], but [in a global/regional context], the standard for sarcoma care [is having] access to [clinicians] that are formally trained in the multidisciplinary management of sarcoma. That involves both orthopedic and general surgical oncologists, as well as medical and pediatric oncologists, and radiation [oncologists]. Some of the other important specialties [include] physical medicine, physical therapy, child life, molecular biology, and pathology. [A multidisciplinary approach to care is critical] to make sure that we have an accurate diagnosis.

What are the downstream implications of these disparities in sarcoma care?

Suboptimal access [is the main issue]. What I mean is that [patients] can see well-intended practitioners who maybe have a certain disciplinary aspect that they are expert in, such as an orthopedic oncologist. However, if that orthopedic oncologist isn't dialed in with a medical or pediatric oncologist, radiologist, or pathologist, [the patient] may go down a [treatment] path that isn't complete. They may not get all of the systemic therapy [they need because] they may not get an accurate diagnosis. It is important that patients get to centers where they can receive comprehensive care.

What else can be done to bridge some of the gaps that currently exist and give patients the best shot at the greatest benefit from treatment?

It depends upon the country in which they're treated and the resources [that country has]. Do they have a national health system? How fragmented are the resources? Awareness would be the first step for the medical community [to address the issue of global access.]

What organizations or governing bodies should be involved in solving these challenges?

The answer is all of the above, and it depends on the health care environment. In the US, we appreciate the complexity of health care. There's not one master health system. There's the National Health System in the United Kingdom, which really does help appropriate these resources and ensure patients get to those centers. There are also countries that have no health systems at all and are just trying to get by with what they [have].

What are some effective avenues for patients with sarcoma to access proper care?

The most important consideration when it comes to advocating for sarcoma is that, [although this tumor type] is rare, there are plenty of people out there on social media and through the connectivity networks of certain foundations who can help patients get to the right centers. Every [patient with] sarcoma has a particular journey and aspect to their care that needs to be addressed. These mechanisms of social media and foundations are advocating for patients. If a given individual feels like they do not have access, they should reach out to the Sarcoma Foundation of America or some other advocacy groups that can get them to the right people at the right place.